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Written by Sidney Harper 

The choice is yours: supporting moms to reach their baby feeding goals

26/08/2014 3:51:09 PM | 17 comments |
A recent article in Today’s Parent has sparked debate on a topic I feel very passionately about:  how do we best support mothers in reaching their feeding goals when it comes to their newborn babies?
 
The feeding plan is a tool nurses can use to support mothers in making informed decisions about their infant feeding goals.  It might be breastfeeding or formula alone, or a mix of both.  Fraser Health’s ultimate objective is to support women to do the best they can do and reach their own feeding goals. This is not a declaration or contract as some people have reported.
 
Like a birthing plan, the feeding plan can change day-to-day, depending on your circumstances.  We know that 95% of women want to breastfeed; and we do what we can to help them do this.  We also know that some mothers, for various reasons, choose to use formula, and our role is to provide as accurate information as possible so they can make informed decisions.
 
What I find most interesting is that our culture seems to be comfortable hearing about the benefits of breastfeeding but seems uncomfortable talking about the risks of artificial baby milks or formula.  Research has shown that there are higher chances of colds, flu, ear infections, diarrhea and vomiting among other illnesses with formula use.
 
It is easy to turn to formula when breastfeeding challenges present themselves.  Mothers who deliver their babies in Fraser Health are offered support and encouragement to increase their confidence and meet their own breastfeeding goals whether in hospital or at home in their community.
 
Breastfeeding is normal and for most babies any breastfeeding is good.  If a woman is breastfeeding but is advised by a health care provider that formula is needed, formula is given as we would give a medicine – the right amount of formula for the right period of time can be very useful.  
 
Nurses in Fraser Health support healthy decision-making and know that breastfeeding can improve short- and long-term health outcomes.  We help women to do the best they can do with regards to infant feeding.  We look at their particular set of circumstances, whether a baby or mother is admitted to an Intensive Care Unit,  whether she has had a c-section, or has had a full-term, healthy baby.
 
Another way in which we support newborns to thrive is by supporting women with skin-to-skin contact with their babies.  Women who have had straight-forward deliveries, difficult births or c-sections can all benefit from getting skin-to-skin contact with their baby.  I know it’s not always easy, and a mother is free to say no to the offer.  When this happens, fathers can step in and help a baby transition from being inside a warm, cozy environment, to one that is totally foreign to them.  Skin-to-skin contact can stabilize a baby’s heart rate, blood sugars, temperature and other systems; contributing to successful feeding.
 
Infant feeding is an emotionally charged topic in our culture.  Our job is to inform women with accurate information, let them make their decision and then support them to achieve their own feeding goals; all the while supporting the long-term health and well-being of both mother and baby.
 
Visit us for more information on Best Beginnings for you and your baby.

 

Update: Wednesday, August 27

We value the public’s feedback on this issue and appreciate the concerns that have been raised about the Mother Baby Feeding Plan form.  We recognize that this form does not reflect our intentions, which was to identify feeding options, educate families and support decisions in a manner that is compassionate and supportive.  We sincerely apologize to anyone who was offended by the content of the form.

While breastfeeding is something we try to encourage, we understand there are circumstances where alternatives such as using formula, or a human milk bank, are necessary. Whatever the decision, it has to meet the needs of parents and infants.
 
Our objective is to support parents in reaching their infant feeding goals. We have decided to remove this form while we review it. A new one will be developed over the next few weeks in consultation with patients, clinicians and experts.
 
The birth of a baby is a joyous occasion and parents and their families shouldn’t feel apprehensive about the feeding decisions they make for their infant children.  If you have received this pamphlet and are worried, please talk to your nurse or doctor, and they will help you make the right decisions for you and your baby.”
 
- Tamara Van Tent, Director of Maternity at Fraser Health


 
Project Development Nurse, Baby Friendly Initiative
Sidney Harper is a public health nurse and is part of Fraser Health's Baby Friendly Initiative.
Comments
Kristin
If you want to inform women with accurate information, why don't you state that three studies you cite contradict each other? The Ip, Chung et. al meta-analysis shows no difference in cognitive function of breast-fed vs non-breast fed children, and it also shows no effect on postpartum maternal weight loss.
Instead, other studies had to be cherry picked to get the results that you are attempting to promote. The Kramer et al study looking at IQ had some major issues, not the least of that it was a study in Belarus, which is hardly applicable to North America.
Regarding post partum weight loss- the evidence is contradictory. A literature review shows multiple studies, some showing no increase in weight loss and some showing a positive weight loss.
In the spirit of true informed consent, may I suggest that you amend your feeding plan form to include this information?
19/02/2015 12:18:03 PM

Lola
I notice that the website you direct blog readers to still states that you do not recommend formula, that infants receive only breastmilk, and has no information on safe formula preparation or handling. I'm disappointed in you.
02/01/2015 5:11:25 PM

Joan M Humphries
I am currently engaged in doctoral research about this topic. Could someone help me get a copy of this document?
04/09/2014 2:46:30 AM

Jennifer Pery
I choose formula. Why? None of your business. Will you still support me Fraser Health?
29/08/2014 7:43:41 PM

Anon
I'm shocked, reading these comments makes me wonder if the current evidence regarding infant nutrition is flawed. Perhaps there is no difference between formula and breastfeeding????
But wait, the good old Cochrane library has a statement,

"Breastfeeding is supported by extensive evidence for short-term and long-term health benefits, for both mother and baby. Babies who are not fully breastfed for the first three to four months are more likely to suffer health problems such as gastroenteritis, respiratory and ear infections, urinary tract infections, allergies and diabetes mellitus."

Regarding the uproar about the form, It sounds like the bottom line is supporting a mothers choice.
Fraser health provides formula for free in hospital, supporting mothers who choose to formula feed. We'll done.
Now, mothers who choose to breastfeed, how are these mothers supported? Does fraser health provide lactation consultants on every maternity ward? Is there enough support when these mothers go home?

So let me summarize, there is evidence supporting healthy outcomes in breastfeed populations, fraser health is committed to supporting all mothers choices, there is free formula in hospital, and minimal support in place for breastfeeding mothers.
29/08/2014 11:15:42 AM

Jamila
I am still a relatively new mother to a happy, healthy little boy who was completely formula fed. Was this my first choice? No it was not. Unable to nurse due to a surgery years earlier made it virtually impossible to breast feed although I struggled for 2 months to try, using lactation consultants, breast pumps, feeding tubes and watching my little guy still progressively lose weight. The never ending guilt of just being a new mom is enough than to have communication such as this beaten into women as though they willingly make a choice to inflict harm or neglect on their child by choosing formula. You likely make a correct point in that 95% of women want to nurse, for the nutrition, the bonding, the deep love you share with your child during these moments. However, this approach was both irresponsible and clearly hurtful to a population of moms who struggle with breast feeding far beyond the challenges that even I've had. Postpartum depression, sleeplessness, shame, guilt and anxiety to name a few. I can appreciate your efforts to educate women on the benefits of breast feeding, but a greater level of empathy, respect and understanding would have been appreciated for those who do struggle rather than what might perceived to a be a guilt trip given that this is a public forum.
28/08/2014 8:41:08 PM

Dr. Christa Mullaly, MD FRCSC, Obstetrician-Gynecologist
This is an appalling and unscientific document; I take issue with its content, language, and tone.
For content, the highest quality evidence, from the randomized trials reported as PROBIT and PROBIT-2, clearly refutes your fuzzy points ("may", "might", "could").
The only proven, validated information that you can provide to mothers is that a) formula-fed infants have a very small increase in risk of viral gastrointestinal infection in the first year of life, and b) formula is really expensive.
For language, vague terms like "might", "may", and "could" are deliberately misleading and suggest greater validity than the science supports.
Finally, the tone of this document is unnecessarily demeaning and cajoling. Its clear intention is to shame women who feed their children formula, even in cases in which formula is indicated and necessary for the infant's health.
I strongly applaud your decision to pull the document and am highly skeptical that any incarnation of this form could respect women, their infants, and their feeding choices.
28/08/2014 6:13:44 PM

Tricia
Unbelievable!
I was not breast fed, I have lived a wonderful healthy life. I am successful working for a major corp , I am stong .That goes along with my brother who is stong, smart ( he's a doctor) with no health issues what so ever! One more!!! My sister, healthy, stong, and is now a police officer. All with wonderful athletic accomplishments through our years.
I now have a 4 year old who has never been sick a day in his life, who is smart, loving, talented at many things oh and he is stunning! This is mind blowing and Fraser health should be ashamed to have even brought something like this forward.
Shame on you and trying to belittle mothers for THEIR choices about THEIR children.
SHAME ON YOU!!!
27/08/2014 6:52:06 PM

Jocelyn
Fraser Health needs to show the multiple, peer-reviewed studies that support each and every single one of the points on that contract. If you cannot, which you will not be able to, because several of the points are utter nonsense, you need to withdraw the points immediately from the "contract."
27/08/2014 5:44:33 PM

Kit
So what if my breastfeeding goals are to formula feed from day one and never give my baby a single drop of breastmilk? Will you support me in my choice?
27/08/2014 5:09:29 PM

Fraser Health
We value the public’s feedback on this issue and appreciate the concerns that have been raised about the Mother Baby Feeding Plan form. We recognize that this form does not reflect our intentions, which was to identify feeding options, educate families and support decisions in a manner that is compassionate and supportive. We sincerely apologize to anyone who was offended by the content of the form.

While breastfeeding is something we try to encourage, we understand there are circumstances where alternatives such as using formula, or a human milk bank, are necessary. Whatever the decision, it has to meet the needs of parents and infants.

Our objective is to support parents in reaching their infant feeding goals. We have decided to remove this form while we review it. A new one will be developed over the next few weeks in consultation with patients, clinicians and experts.

The birth of a baby is a joyous occasion and parents and their families shouldn’t feel apprehensive about the feeding decisions they make for their infant children. If you have received this pamphlet and are worried, please talk to your nurse or doctor, and they will help you make the right decisions for you and your baby.”

- Tamara Van Tent, Director of Maternity at Fraser Health
27/08/2014 3:47:29 PM

Clara
I would be very interested to see references for your claim that "even one feed of formula may cause permanent damage". This is known as the 'virgin gut theory' and is notorious for being pseudoscience circulating on breastfeeding blogs and websites. To my knowledge it does not correspond to any legitimate medical condition. I would be interested to learn why Fraser Health feels this piece of folklore merits mention on a document meant for patient education?
Also, I wonder where the disadvantages of breastfeeding and advantages of formula are on your contract? By definition, providing the patient with only the benefits of one option and the risks of the other, you are not providing informed consent but manipulation.
I am sure that both these issues would be in clear violation of the ethical code of any self-respecting health care facility. What are you going to do about it?
27/08/2014 12:59:11 PM

Liz
"The choice is yours: supporting moms to reach their baby feeding goals"

As long as you make the choice we think is best, and your baby feeding goal does not involve formula! XOXO!
27/08/2014 8:49:59 AM

Tsu Dho Nimh
Who wrote it?
Who approved it?
Who had the responsibility for fact checking it?

If you removed ALL statements that have weasel-wording such as "may, might, are thought to" what is left?

How about explaining those scary % increases in risks into wording a non-statistician and non-epidemiologist who does not have access to the original studies can understand? Or is scaring the crap out of people with free-floating numbers your objective?

If you put as much time and effort into actually SUPPORTING new mums as you apparently do in handing them a heavy-handed guilt trip those who cant (physically or economically) breastfeed might not feel like such failures.
27/08/2014 7:12:19 AM

supermouse
What about the risks of breast feeding, and the benefits of formula? If those are not included then you are not giving informed consent.
27/08/2014 5:27:15 AM

Marni
If you want to inform women with accurate information, why don't you state that three studies you cite contradict each other? The Ip, Chung et. al meta-analysis shows no difference in cognitive function of breast-fed vs non-breast fed children, and it also shows no effect on postpartum maternal weight loss.

Instead, other studies had to be cherry picked to get the results that you are attempting to promote. The Kramer et al study looking at IQ had some major issues, not the least of that it was a study in Belarus, which is hardly applicable to North America.

Regarding post partum weight loss- the evidence is contradictory. A literature review shows multiple studies, some showing no increase in weight loss and some showing a positive weight loss.

In the spirit of true informed consent, may I suggest that you amend your feeding plan form to include this information?
26/08/2014 6:13:40 PM

Amy Tuteur, MD
The contract exemplifies everything wrong with contemporary breastfeeding advocacy: it is demeaning, infantilizing, it tramples on a woman’s right to control her own body, and it is makes claims that are not supported by science.

This is mother shaming at its most egregious. Fraser Health should withdraw the breastfeeding contract immediately, and issue an apology for ever using it in the first place.
26/08/2014 5:16:53 PM

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